CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Elkhart General Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $94
Cash Discount Price: $92
vs. Medicare Baseline: 2.90x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Elkhart General Hospital is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $92. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.90x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $92 (284%)

Insurance Median: $94 (290%)

Cash: $92 (284% of Medicare)

Ins. Median: $94 (290% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 290% of the Medicare baseline (a markup of 190%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Mclaren (Mi	$16	49%
UnitedHealthcare	$16 - $95	49%
Blue Cross Blue Shield	$26 - $58	80%
Devoted Healthcare	$28 - $32	86%
Aetna	$31 - $96	96%
Humana	$31 - $99	96%
Pace	$31	96%
Plain Church	$46 - $114	142%
Caresource	$49 - $185	151%
Mhs	$55 - $185	170%
Cha	$85 - $111	262%
Immergrun	$85 - $114	262%
Php	$92 - $99	284%
Cigna	$102 - $108	315%
Multiplan	$102	315%
Signature	$104	321%
Encore	$105	324%
Heartland	$142	438%
Mdwise	$185	571%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $92.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Elkhart General Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.